"It is health that is real wealth, and not pieces of gold and silver." Mahatma Gandhi said.
A wealth, that we mostly only appreciated when missing. The current pandemic and the news coverage of it is reminding us of this wealth. With the exponential spread of the disease, the stringent policies and regulations related to the lockdown, civilians and governments behaviors and actions are changing. Governments intend to 1) improve life of civilians during the current times and 2) prevent any further pandemic.
Today's blog entry focuses on what else governments should keep in mind to avoid being blindsided by side effects of solely dealing with curing COVID-19 and preventing another pandemic.
Let's watch out for leaders using blinkers, blinded by everyone's focus on the current pandemic. While we are shifting the way things are working, let's fix pre-Covid related healthcare problems at the same time. Let's make sure governments keep their eyes fully open while taking crucial (hopefully goodhearted and well intended) decisions, that will be impacting our lives and those of our children.
Healthcare Systems: Pre Covid
What is a healthcare system supposed to deliver?
The New Yorker writes: "Medicine isn’t a doctor with a black bag, after all; it’s a complex web of systems and processes. It is a health-care delivery system—providing antibiotics to a child with strep throat or a new kidney to a patient with renal failure. It is a research program, guiding discoveries from the lab bench to the bedside. It is a set of protocols for quality control—from clinical-practice guidelines to drug and device approvals. And it is a forum for exchanging information, allowing for continuous improvement in patient care."
A healthcare delivery system, a research program, a quality control program and a forum for information exchange. A healthcare system is also a network of stakeholders - from insurance companies, to doctors, to hospitals, to the pharmaceutical and medical device industry to pharmacies. Each representing their own interests. With all these stakeholders in mind, healthcare has always found some space on the agenda of politicians. The point is, that stakeholders' power has always determined which interests are represented on a governmental level. As an example, in the US, statistics show that top lobbying spending in 2012-2013 was 12 bn usd in guns, 127 bn usd in defense and 230 bn usd in pharma. Just think about this for a moment.
A healthcare system is intended to heal people. What it does in reality is, keep people ill. It sounds controversial, but I truly believe, that the entire healthcare system is built on making money off of ill patients. Can you imagine the healthcare system, that we have now, surviving without ill patients? Just imagine for a moment: hospitals, pharmaceutical companies, doctors, pharmacists, medical device companies wouldn't be making any money. Can we imagine a world where healthcare systems are built with aligning interests between the healthcare service providers and the patients?
In ancient Chinese times, doctors were paid to keep people healthy, not per treatment. In a previous article on healthcare systems, I have quoted Matthiaus Muellenbeck. He had an idea on how to govern the healthcare system and gave a TED Talk with the title: "What if we paid doctors to keep people healthy?". He states that "30% of all surgical procedures were conducted although other nonsurgical treatment options had not been fully exploited". The way systems are incentivized are how they will run.
COVID-19 is putting a lot of attention to healthcare systems. Governments should use this momentum, not to turn it "back to normal" but to use this opportunity to fix both the current pandemic and the pre-COVID issues, at the same time. The New Yorker writes: "But, as a physician and researcher, I fear that the resumption of normality would signal a failure to learn. We need to think not about resumption but about revision." And I couldn't agree more.
Healthcare Systems: Covid
Let's put the deaths of COVID-19 into perspective. Above is an image of the deaths by disease per day. The Visual Capitalist created this in May 2020. See the comparison between Cardiovascular diseases vs. COVID-19.
The Corona Virus is not something to take lightly and it is important that governments do their best to 'flatten the curve' of the current spread in various countries, but we need to make sure not to lose sight of the other healthcare issues that need to be solved. The New York Times writes about the US, that the "administration [is] unwilling to intervene to force businesses to act en masse to resolve a public health crisis like this, and you get what we got: a messy, uncoordinated under-response, defined by shortages and finger-pointing." A different approach has been taken by South Korea, as the New York Times write: "In contrast, South Korea, with its national health system, engaged its private test manufacturers with a plan in January, promising them quick approval for a coronavirus test and the widespread use of it in nationally organized and financed testing. With a guaranteed market, 10,000 tests a day were available within weeks, allowing the country to avert a shutdown. The federal government or the C.D.C. might have played that role in the United States, but did not."
With the media coverage of COVID-19 and consequently the pressure this creates on the government to "do something" to support, I understand, as Leaders are only humans, that they initially act out of fear, enforcing full lock downs based on panic and inexperience of this situation. That's why it is so important to take some perspective and think about the decisions taken. Some countries have initiated full lockdowns with the purpose to reduce the number of COVID-19 infected and deaths. These full lockdowns have however caused unintended side effects, such as lack of vaccine delivery in Africa risking further spread of other diseases, such as Malaria, or effecting severe poverty with death as a consequence to day laborers in India, or causing police brutality and aggressiveness across Africa, leading to more deaths than the virus itself (lowy Institute), for example. The UN High Commissioner for Human Rights noted that “people are dying because of the inappropriate application of measures that have been supposedly put in place to save them” (Quote: the interpreter).
If people only focus on the number of deaths caused by COVID-19, countries, which have initiated a full lockdown, will be "better off" in terms of infected COVID-19 patients and deaths, compared to those with less severe policies. Consequently we will be given a false image of the actual situation in these countries. The economic or healthcare related consequences or side effects of a full lockdown are as severe as the virus itself. Countries need to be considering these consequences when determining whether they are dealing with the pandemic in a good way or not. WHO suggests: "As countries steel themselves against future health crises, they should not ignore basic investments in their health systems." The Director General of WHO further states:“Strong and resilient health systems are the best defence not only against outbreaks and pandemics, but also against the multiple health threats that people around the world face every day."
Healthcare Systems: Post Covid
In order to get out of this crisis - looking at revision, rather than resumption, as the New Yorker called it, I want to emphasize that we need to use the momentum of the current pandemic to revise the full healthcare system. The aspects that need to be considered are:
The System Infrastructure
Integration of Education woven into the healthcare system
Provision of multi-facetted Healthcare Services
With the current pressure governments are facing, we need to make sure that leaders do not cloud their decisions they make with the pandemic, but keep the big picture of people's health in perspective.
1) System Infrastructure
Two things need to be considered in the basis of the system infrastructure. Whether the healthcare system is market based or government based universal healthcare, it is important to understand the revenue streams: who is incentivized for what service provided? Who is incentivized for what service and are service providers, whether the doctor, the hospital, the pharmaceutical company, really incentivized to keep people healthy? With the adjustment of revenue streams and innovation of new system models, I am convinced we will be able to create a system where the incentivization routes are aligned with those of the patients: a system where stakeholders earn money with keeping people healthy. This can be realized if we set our hearts and minds to it. With the set up of a strong infrastructure, we will see the outcome with a rise in health, a rise in responsibility of one's own health, a significant decrease in chronic lifestyle related diseases and system-related a new way of collaboration, and not wavered finger-pointing competition.
2) Integration of Education woven into the healthcare system
COVID-19 has created a tremendous amount of workload to the primary healthcare channel. With both centralized and scattered communication streams filled with educating population on how to take care of their health, can relieve the burden on the primary healthcare system significantly. This will allow the primary healthcare channel to handle more severe cases with more attention and focus. Education is not only meant to reduce the workload of primary care, but also increase the knowledge on prevention. So many of the diseases leading to Cardiovascular Health issues leading to most deaths per day, are preventable or manageable with healthy food and lifestyle choices. Education can solve so many issues within healthcare, and having it woven in the foundation of the healthcare system will benefit both service providers and service receivers.
3) Embracing Digitalization:
Since the COVID-19 pandemic, the telemedicine sector is booming. Recent technologies of remote patient monitoring and remote disease management offer services supporting patients and healthcare service providers. These innovations should be supported and embraced. With these technologies and with the right revenue streams (see system infrastructure), I strongly believe that our healthcare systems can move forward creating an environment of healthy patients. Governments should support this trend and invest in new innovations within this business segment.
4) Provision of multi-facetted Healthcare Services
Until now our healthcare system provided one main service: healing physical illnesses. When the momentum of the current pandemic is used to fully revise the healthcare system, I want to explore three more areas that need equivalent (!) attention as healing physical illnesses. Together four areas need equal attention:
Cure of mental health diseases
Cure of physical health diseases
Prevention of mental health diseases
Prevention of physical health diseases
Mental health issues are loaded with stigma in so many countries across the world, which inter-woven education can lift. The objective of governments should be to provide equal investments and service provision towards mental health issues as to physical health issues.
The other two aspects to consider are prevention of physical health issues and prevention of mental health issues.
“Prevention is not only better than cure,” said the Director General of WHO, “it’s cheaper, and the smartest thing to do." Governments should take Director General's advice literally and translate these recommendations into policies realizing these services and support to all civilians. Above graph from McKinsey shows how consumers' behaviour is already shifting towards Exercising and Meditation / Mindfulness.
Above four aspects (The System Infrastructure, Integration of Education woven into the healthcare system, Embracing Digitalization, Provision of multi-facetted Healthcare Services) are necessary to create a healthcare system built on a foundation of compassion, healing and love. Governments carry a responsibility as to which shortcomings in the healthcare system they intend to address. Instead of radically focusing on pandemic, let's use the opportunity of revising the full healthcare system.